Plasma concentration following oral administration of di- and flucloxacillin in infants and children

Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants

Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units.

Penicillin - getting prescribing right for children

Penicillins are commonly prescribed to children. Recommendations in the product information may not be the most appropriate doses for children and may list clinical indications that are preferably treated with other antibiotics

Reputable guidelines, for example Therapeutic Guidelines: Antibiotic, offer up-to-date advice on optimal choice, route, dosage and duration of oral penicillins in children

In most instances, the child’s weight should be used to calculate the dose in mg per kg without exceeding the maximum adult dose

When prescribing higher weight-based doses of amoxicillin or flucloxacillin, check the volume of oral liquid required to complete a treatment course to ensure adequate supply

Electroencephalographic effects of flucloxacillin in rats

The neurotoxicity of flucloxacillin, an isoxazolyl derivative of beta-lactamic antibiotics, was studied in rats by electroencephalographic recordings. The results show that intravenous flucloxacillin, (200 mg/kg) produced cortical activity modifications. The changes in electroencephalogram consist of irritative activity patterns and bursts of high voltage waves with spikes and polyspikes. The effects of other beta-lactamic drugs (cloxacillin, ampicillin-sulbactam and penicillin G) on electroencephalography activity were also investigated after intravenous administration of equivalent doses. These drugs did not change the normal bioelectric cerebral activity of the rats.